IN RECENT YEARS, how to regard the "forms of consciousness entirely different" induced by mescaline, LSD25, and psilocybin has posed a seemingly perplexing issue. For articulate self-experimenters from Mitchell to Huxley, mescaline has provided many-splendored visual experiences, or a life-enlarging sojourn in "the Antipodes of the mind." ² For Stockings, it may be recalled, mescaline produced controlled schizophrenia ³ a thesis which earned the Bronze Medal of the Royal Medico Psychological Association and apparently inaugurated, in conjunction with the advent of LSD-25, a period of concerted chemical activity in the exploration and experimental induction of "model psychoses." ⁴ In counterpoint, this same so-called "psychotomimetic" LSD has increasingly found use as a purposeful intervention or "adjuvant" in psychotherapy⁵ The recently arrived "magic mushroom," psilocybin, has been similarly equivocal--"psychotogenic" for some, "mysticomimetic" for others⁶ The present paper will review the literature on drug experience--paying particular attention to the effects of extradrug variables, for the realization of the extent of their potential influence has only recently crystallized, and promises to reduce some of the abundant disorder in this area.

  The phenomenon of drug-associated rapid personality or behavior change will be discussed in some detail. For example, a number of different alcoholic treatment facilities, especially in Canada, have reported, for many of their patients, complete abstinence after a single LSD session.⁷ More generally, neurotic ailments over the full range have been described as practically evaporating.⁸ Given this picture, and the present state and practice of the therapeutic art, it is not surprising to find at least one psychiatrist envisioning "... mass therapy: institutions in which every patient with a neurosis could get LSD treatment and work out his problems largely by himself." ⁹ James would have been much attracted by the "spectacular and almost unbelievable results" ¹⁰ reported on the modern drug scene; and, in fact, their resemblance to the "instantaneous transformations'' attendant on "mystical" religious conversions which he discussed so eloquently may well be more than superficial and seems worthy of attention.

  Since the evidence and testimony accumulated over the years on the separate drugs will be treated interchangeably, this raises a preliminary point of some importance. Although the conclusion was delayed by both dissimilarities in their chemical structure and differing modes of introduction to the scientific community, it is now rather commonly adjudged that the subjective effects of mescaline, LSD25, and psilocybin are similar, equivalent, or indistinguishable. Both Isbell and Abramson have administered LSD and psilocybin in the same study; Wolbach and his coworkers have administered all three. All have found that their subjects were unable to distinguish between the drugs¹¹

    The reported equivalence in subjective reactions seems quite consistent--or at least not inconsistent--with present pharmacodynamic knowledge. Studies of radioactively tagged mescaline and LSD indicate that the compounds largely disappear from the brain in relatively short order--in fact, at about the same time that the first "mental phenomena" make their appearance¹² Hence, it has been tentatively suggested that the characteristic effects, which persist for a relatively long period, are to be attributed not to the action of the drug itself but to some as yet unidentified aspect of the chain of events triggered by drug administration. Isbell, observing the "remarkably similar'' reactions to LSD and psilocybin, hypothesized "some common biochemical or physiological mechanism" to be responsible for the effects--that is, that the various compounds share a final common path¹³ The most direct support for this inference of biological identity in ultimate mechanism of action has come from cross tolerance studies wherein subjects rendered tolerant to one drug--that is, non reactive after repeated administrations have then been challenged by a different drug. Present indications are that cross tolerance among the drugs does in fact develop.¹⁴

    This is not intended to suggest that a drug experience is invariable among subjects quite the contrary has been the case. In fact, experiences even for the same subject differ from one session to the next¹⁵ But when relevant extradrug variables are controlled, the within-drug variance is apparently coextensive with between-drug variance, and is attributable to ubiquitous personality differences; in other words, while a range of reactions is reported to all of the drugs, there is no reaction distinctively associated with any particular drug. Extradrug variables, which have been uncontrolled and largely unrecognized until recently, are apparently responsible for much of the variance erroneously attributed to specific drug action.

    By common consent, the drug experience is paranormal--that is, beyond or outside the range of the normal, the everyday. Exclamations of "indescribable'' recurrently appear in the literature. However, whenever descriptions are essayed, there is relative unanimity about certain features. These, it may be said, are attributable to the drug administration, per se, independent of the personality of the subject, the setting, or the experimenter's or subject's expectations. A sampling from the literature of subjective reports and testimony may communicate, or at least transmit the flavor of, these invariant reactions.
    First, and perhaps most easily conveyed, is the characteristic of the drug experience called by Ellis a "saturnalia" or "orgy" of vision¹⁶ Subsequent authors have been only slightly more restrained:

    A second invariant set of drug reactions, more difficult to characterize or communicate, has been called, variously, depersonalization, dissociation, levitation, derealization, abnormal detachment, body image distortion or alteration, and the like:

    Some degree of depersonalization probably occurs during every LSD experience . . . the detachment of the conscious self, a sort of detached ego. This self is in touch with reality and is in touch with the self experiencing the psychic phenomena.²⁴

    Regardless of whatever else a drug experience may be reported to include, alterations in visual experience and in experience of self, as detailed above, may be predicted with considerable confidence.²⁵

    In connection with the so called dissociation phenomenon--and in view of the connotations of the "psychotomimetic" and "intoxicant" labels--it may be well to emphasize that drug experiences, at least for most nonpsychotic subjects, do not seem to approximate delirium:

The mescal drinker remains calm and collected amid the sensory turmoil around him; his judgment is as clear as in the normal state .... ²⁶

It is difficult to classify the state of conscious ness during the intoxication which allows such self-observation and, at times, seems to foster detachment and selfscrutiny.²⁷

... in a state of clear consciousness [the subject] . . . is able to describe in detail the manifold mental changes during drug intoxication.²⁸

    The non-delirious condition of normal volunteers, at least with low to moderate drug dosage, has been objectively attested by their ability to perform psychological tests. The most exhaustive series of investigations along this line has been carried out for LSD by Abramson and his associates.²⁹ Generally, although not consistently, subjects show slight decrements in performance--at least some of which may well be attributable to an altered state of attention-motivation affect. However, the test setting itself seems to contaminate the drug experience; Savage, among others, has noted "a less profound effect when subjects are kept busy doing psychological tests .... "³⁰
    Another and final set of seemingly invariant reactions concerns the retrospective impressiveness of the drug experience. The succession of testimonials to this effect is a striking and salient feature of the history of research with these compounds:

After the above renditions, a querulous reader may be concerned about the appellation "psychotomimetic drugs." So are many contemporary researchers and therapists, too numerous to mention. Holiday has provided a trenchant analysis of "how the semantics in the field of psycho pharmacology became so confused and generally misleading"; ³⁶ here, only a few points will be noted.

Early mescaline investigators clearly tempered their comparisons between the mescal-induced state and the hallucinations and dissociations of endogenous psychosis. As far back as 1930, it was found that when chronic schizophrenics suffering from persistent hallucinations were given mescal, they distinguished the mescal phenomena, remarked on their appearance, and usually blamed them on the same persecutors who had molested them before? Klüver, though he foresaw and extensively discussed the "model" values of mescal, persisted in calling it "the divine plant." ³⁸ It was apparently difficult to consider a sacramental substance--"the comfort, healer, and guide of us poor Indians . . the great teacher" ³⁹--as unequivocally psychotomimetic. With LSD, a laboratory-born drug having no history to contend with, the situation changed. The adventurous Hofmann, on that fateful day in 1943, started his self-experiment with 250 micrograms of LSD, thinking, as he put it, that such a small amount would probably be harmless. His response to this quite large dose--in terms of present-day experimental standards--was as follows:

    Hofmann went on to list, as his most marked symptoms, visual disturbances, motor restlessness alternating with paralysis, and a suffocating sensation, and added: "Occasionally I felt as if I were outside my body. My 'ego' seemed suspended in space .... " ⁴¹ Stoll, who in 1947 reported experimental confirmation of Hofmann's experience, is widely reputed to have warned informally of a case of suicide as the after math of an experimental trial. The most common accounts thereafter had a psychotic female subject committing suicide two weeks after the administration; or, in another version, a subject committing suicide after the drug had been administered without her knowledge. At any rate, this story, though itself never appearing in print, is referred to in one form or another in nearly all of the early work with LSD; it apparently influenced experimenter attitudes for a number of years. For many and varied reasons, too involved to trace here, the initial formulation of the "model psychosis" properties of LSD engendered enormous investigative enthusiasm. In this climate, latent reservations on the score of psychotomimesis tended to go unvoiced. In the more recent, post-enthusiasm era, however reservations have been more or less vigorously expressed--for example:

    Many alternatives to the "psychotomimetic" characterization of "hallucinogenic'' agents have recently been proposed In 1957, 0smond offered, among others, "psychelytic" (mind-releasing) and "psychedelic" (mind-manifesting).⁴³ Other investigators have proposed consciousness-expanding, transcendental, emotionalgenic, mysticomimetic, and so forth. It becomes ever more apparent, though, that old labels never die.⁴⁴

    It may probably be stated as a pharmacopoeial commonplace that the effects of a drug administration of any kind are likely to be compounded by factors other than specific pharmacologic action. Often this is attributed to "personality," to individual differences.⁴⁵ However, though there have been as yet very few con trolled investigations in the case of the drugs considered here, it has become abundantly clear from the systematic variability reported in subject and patient reactions--in both the affective and ideational dimensions of drug experience--that factors other than "personality" are also at issue.

    Affective reactions attendant on a drug administration have varied, according to reports, all the way from hyperphoric ecstasy to unutterable terror--though not with ail investigators. The opinion leader Hoch, through a decade of observations, consistently maintained:

The following interchange was recorded at the 1959 conference on the use of LSD in psychotherapy held under the auspices of the Josiah Macy, Jr., Foundation:

  Hoch: Actually, in my experience, no patient asks for it [LSD] again.
  Katzenelbogen: I can say the same.
  Denber: I have used mescaline in the office . . and the experience was such that patients said, "Once is enough." The same thing happened in the hospital. I asked the patients there if, voluntarily, they would like to take this again. Over 200 times the answer has been "No." ⁴⁸

Subsequently, Malitz also stated:

None of our normal volunteers wanted to take it [LSD] again.⁴⁹

    In contrast, DeShon and his coworkers reported the results of the first LSD study done with normal subjects in this country as follows:

... anxiety was infrequent, transient, and never marked .... All subjects were willing to repeat the test.⁵⁰

The experience of other investigators has been similar:

During the past four years we have administered the drug [LSD] hundreds of times to non-psychotics in doses up to 225 micrograms.
... Those who have participated in these groups are nearly always definitely benefited by their experiences. Almost invariably they wish to return and to participate in new experiments.⁵¹

    The rapidly expanding use of LSD in psychotherapeutic contexts has provided highly revealing clues to the patterning of extra-drug variability. Busch and Johnson were the first to report administering LSD to neurotic patients whose therapy had "stalled" and whose prognosis was "dim." The result was "a reliving of repressed traumatic episodes of childhood," with "profound" influence on the course of therapy.⁵³ Sandison and his colleagues also found that LSD "produces an up surge of unconscious material into consciousness,'' ⁵⁴ and that "repressed memories are relived with remarkable clarity" ⁵⁵ --with therapeutically beneficial con sequences.
    Since these early reports, whenever psychoanalytically oriented therapists have employed LSD, practically without exception the patient relives childhood memories. The interesting point is that this phenomenon has practically never been noted in the experimental literature!
    Jungian therapists, on the other hand, have repeatedly found that their patients have "transcendental" experiences--a state beyond conflict--often with rapid and dramatic therapeutic results. As a matter of fact, in an amusing and some what bemused account, Hartman has described his LSD-using group comprised of two Freudians and two Jungians, in which the patients of the former report childhood memories, while those of the latter have "transcendental" experiences. In addition, for Jungian patients, the transcendental state is associated with "spectacular" therapeutic results, while for Freudians, should such a state "accidentally'' occur, no such spectacular con sequence is observed.⁵⁶
    While not from a therapeutic setting, the reports which have emanated from Harvard are noteworthy on the score of ideational content. Under psilocybin, Harvard subjects do not relive their child hood experiences, but grapple with age old paradoxes:

    Without multiplying or belaboring divergences further, it should be apparent that affective reactions and ideational content may be systematically variable dimensions of drug experience; in addition, the possible therapeutic uses or con sequences, however these are conceived, seem clearly variable. Once these "facts" are arrayed, in Baconian fashion, they nearly speak for themselves. At the Josiah Macy conference, the emerging consensus was perhaps best expressed by Savage:

    This meeting is most valuable because it allows us to see all at once results ranging from the nihilistic conclusions of some to the evangelical ones of others. Because the results are so much influenced by the personality, aims, and expectations of the therapist, and by the setting, only such a meeting as this could provide us with such a variety of personalities and settings. It seems clear, first of all, that where there is no therapeutic intent, there is no therapeutic result . . . I think we can also say that where the atmosphere is fear-ridden and skeptical, the results are generally not good . . . This is all of tremendous significance, for few drugs are so dependent on the milieu and require such careful attention to it as LSD does.⁵⁸

The same conclusion has come from experimental quarters as well--for example:

    More specifically, anxiety in the therapist or experimenter about administering the drug, about "inducing psychosis," seems likely to render the experience anxiety-ridden for the subject. Abramson has flatly declared: "The response of the subject . . . will depend markedly upon the attitude of the therapist . . . In particular, if the therapist is not anxious about the use of the drug, anxiety in the patient will be much decreased ⁶⁰ Hyde has reported that "impersonal, hostile, and investigative attitudes" arouse hostile and paranoid responses.⁶¹ Sandison has observed that the occurrence of anxiety seems largely to depend on "what the patient is told beforehand [as well as] rumors and myths current among patients and staff, or even in the press, about hallucinogenic drugs." ⁶² Huxley had intimated this before it became clarified in the psychiatric literature:

    That the positive or negative character of the experience can be systematically directed, overriding even personality factors, seems now to have been fairly conclusively demonstrated With "adequate" preparation--that is, with the specific intent of rendering drug experiences "positive" approximately 90 percent of the subjects or patients, in each of the two most recent studies, reported at least a "pleasant" or "rewarding" session, and nearly as many called it "an experience of great beauty" or something equally superlative.⁶⁴
    In content, as in affect, subjects apparently respond to the implicit or explicit suggestion or expectation of the therapist or experimenter. The Harvard subjects were prepared for their metaphysical binges, it may be noted, with such assigned readings as the "Idols of the Cave" parable in Plato's Republic and passages from The Tibetan Book of the Dead. The preparation of psychotherapy patients hardly needs specification.
    Finally, what may be said about therapeutic implications?--given the fact that the compounds under discussion may induce a powerful paranormal experience whose affective and ideational content can be guided. 0nly perhaps that the extent to which the experience can serve as a useful adjunct to traditional interview therapies, or vice versa, or even as a "complete therapy" would seem to depend on the particular practitioner of the art--his conceptions of therapeutic gains and con sequences, his philosophy and enthusiasm, and his orientation toward "placebo" or "faith" cures.⁶⁵ Schmiege has summarized the current state of affairs as follows:

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